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General NPI Number Information
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NPI Number | 1093054413
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Entity Type | Organization
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Legal Business Name | LIFE CENTER COUNSELING AND RESOURCES
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 1 W COURT SQ SUITE 750
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City | DECATUR
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State | GA
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Zip | 30030-2538
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Country | US
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Telephone | 404-425-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 3949 PERRY PASS
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City | LITHONIA
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State | GA
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Zip | 30038-7730
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Country | US
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Telephone | 404-425-8757
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR/PSYCHOTHERAPIST
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Name | LATOYA K. WILLIAMS
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Credential | MSW
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Telephone | 404-425-8757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005120
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License Number State | GA
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